Hospital ERs begin taking reservations

The first time Erol Uner went to the emergency room recently, he knew something was seriously wrong because fluid retention had caused his legs to double in size. He was seen right away and wound up being hospitalized for two weeks for treatment of congestive heart failure and kidney disease.

People who arrive in the ER with less pressing issues often have to wait for care, sometimes for hours. But when a minor complication sent Uner back to the emergency room at St. Alexius Medical Center in Hoffman Estates, he was able to make an appointment online and practically waltz right in.

"Instead of sitting there in the waiting room with everybody else coughing and with colds, I could wait at home," said Uner, of Schaumburg. "I got there and probably waited less than five minutes."

St. Alexius is one of more than a dozen Chicago-area hospitals that have begun posting ER wait times on the Internet or allowing patients to reserve a place in line from their homes. Administrators say they hope to put an end to the long, unpredictable and uncomfortable waits people associate with emergency rooms.

But adding such conveniences is about more than the warm and fuzzy side of medicine. Hospitals paid by Medicare are now required to report whether they are trying to reduce their ER wait times. And a decline in payments from the government and insurance companies is pressuring hospitals to explore new strategies that will attract new patients and boost revenues.

Some experts also question whether such services might send a mixed message to people with life-threatening symptoms. Those patients shouldn't waste time looking for the shortest line, doctors say; they should go directly to the nearest ER, where they will be seen immediately — regardless of anyone's appointment.

Patients have been slow to take advantage of the services, but the numbers have been growing. At Swedish Covenant Hospital in Chicago, more than 150 patients have made reservations via an online check-in since September, when administrators first offered the service.

"We're trying to use technologies appropriately, and we're trying to be very patient-centered," said Mark Newton, president and CEO at Swedish Covenant. "We're trying to give the patients tools so they can access care more efficiently."

Around 5:30 p.m. on a recent Friday, patients could log on to their computers and decide whether to drive to Rush-Copley Medical Center in Aurora, where the posted wait time was 10 minutes; visit the hospital's other emergency facility in Yorkville, where there was no wait at all, or go somewhere else entirely.

At Edward Hospital's emergency room in Naperville, patients could expect a four-minute wait — or only one minute at its Plainfield location, according to that hospital's website.

Wait time is measured as the average time from arrival and check-in to the time when the patient is placed in a room and treatment can be started.

Edward Hospital's wait times are accessible via app, text, online and phone. In addition, the health system posts the information on digital billboards in Plainfield and Bolingbrook, a move that a hospital administrator acknowledged was as much about brand exposure as customer service.

Experts say hospitals' motive for offering such information is clear: bringing in patients and creating new revenue streams. Emergency departments are a crucial pipeline for people who require hospital stays and tend to bring in the most money.

But hospitals are after even those patients who don't need intense treatment. Once hospitals get new patients in the door, they can funnel them through primary-care physician groups — either owned by the health system or affiliated with it — for follow-up care, raising their chances to hold on to those customers over the long term.

Such strategies reflect the intense pressure hospitals are under as a result of reimbursement cuts from Medicare and Illinois' Medicaid program that start this year. At the same time, as many as 30 million Americans are expected to gain health insurance coverage starting in 2014, creating a vast new pool of potential customers.

For the trade-off to work for hospitals, they must gain a share of those new patients, many of whom will be covered by private insurance, which tends to pay better than government-sponsored health insurance.

At the same time, hospitals are facing a continued decrease in inpatient visits as more services shift to outpatient. In 2011, the last year for which data were available, the number of inpatient days at Chicago-area hospitals dropped by 1.9 percent, the fourth consecutive year of decline, according to the Illinois Health Market Review 2012, an annual report produced by health care consultant Allan Baumgarten.